Improved antiretroviral refill adherence in HIV-focused community pharmacies

被引:26
作者
Cocohoba, Jennifer M. [1 ]
Murphy, Patricia [2 ]
Pietrandoni, Glen [3 ]
Guglielmo, B. Joseph [1 ]
机构
[1] Univ Calif San Francisco, Sch Pharm, San Francisco, CA 94143 USA
[2] Walgreens, Clin Outcomes & Analyt, Chicago, IL USA
[3] Walgreens, Specialized Dis Programs, Serv Pharm, Chicago, IL USA
关键词
Antiretroviral agents; medication adherence; community pharmacy; human immunodeficiency virus; medication therapy management; MEDICATION THERAPY MANAGEMENT; VIRAL LOAD; ASHEVILLE-PROJECT; ECONOMIC OUTCOMES; INHIBITOR THERAPY; DRUG-RESISTANCE; PILOT PROGRAM; SELF-REPORT; PROTEASE; ERRORS;
D O I
10.1331/JAPhA.2012.11112
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Objective: To determine differences in patient characteristics, antiretroviral therapy (ART) regimen characteristics, and regimen refill adherence for human immunodeficiency virus (HIV)-focused pharmacy (HIV-P) versus traditional pharmacy (TP) users. Design: Retrospective cohort study. Setting: California Walgreens pharmacies from May 2007 to August 2009. Participants: HIV-positive patients with greater than 30 days of antiretroviral prescription claims. Intervention: Deidentified prescription records for patients filling any ART prescription at any California Walgreens pharmacy during the study period were assessed. Main outcome measures: ART regimen refill adherence (calculated by modified medication possession ratio [mMPR]) and dichotomous measure of optimal adherence of 95% or greater. Results: 4,254 HIV-P and 11,679 TP users were included. Compared with TP users, HIV-P users traveled farther to pharmacies (5.03 vs. 1.26 miles, P < 0.01). A greater proportion of HIV-P users filled prescriptions for chronic diseases (35% vs. 30%) and received fixed-dose combination antiretroviral tablets (92% vs. 83%) (all P < 0.01). Median mMPR was higher for HIV-P users (90% vs. 77%, P < 0.0001). After adjusting for age, gender, insurance, medication use, and distance from pharmacy, use of HIV-P (odds ratio 1.90 [95% CI 1.72-2.08]) and fixed-dose combination antiretroviral tablets (3.34 [2.84-3.96]) were most strongly associated with having 95% or greater ART regimen refill adherence. Conclusion: For HIV-positive patients struggling with antiretroviral adherence, clinicians may consider minimizing pill burden with combination tablets and referral to an HIV-focused pharmacy.
引用
收藏
页码:E67 / E73
页数:7
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